Lame Duck Congress Likely to Mull Health Bills

Appropriations, Part B premium fix probably in the mix post-election

WASHINGTON -- It may be hard to believe, but on Nov. 9th, the presidential election will be over, and soon after that Congress can get back to its real job, which includes passing healthcare legislation.

The question is, what legislation will it pass? This is especially tricky during the "lame duck" session -- the time after the election but before the new Congress takes over in January. And it's not a very long time -- for example, if lawmakers want to make sure the government has enough money to keep running, they will be in session for just 12 days after the election until Dec. 9, when the current "continuing resolution" on the budget runs out.

As for other items, according to the House calendar, the House will be in session for 16 days from Nov. 8th through the end of the year. (The Senate calendar suggests that body will be in session for 20 days during that same period, but obviously the Senate can only do so much by itself.)

Spending Bill Needed

So what healthcare-related legislation is likely to be high on the congressional agenda during the lame duck period? Passing some sort of bill to keep the government running -- whether it's a "continuing resolution" that temporarily extends current spending or an actual "omnibus" budget appropriation (with increased spending) for the entire fiscal year -- is at the top of the list, according to experts interviewed by MedPage Today.

"Having a continuing resolution would be a disaster in many respects," Andrew Sperling, director of federal affairs at the National Alliance on Mental Illness (NAMI), a mental health advocacy group in Arlington, Va., said in a phone interview. "We have to have an omnibus appropriation."

If current spending were simply extended for another year, "the National Institutes of Health itself would lose over $2 billion" in additional spending that is called for in the appropriations bill, Sperling said. "For mental health, there is close to [an additional] $80 million [budgeted] for the National Institute of Mental Health that wouldn't happen ... Under a continuing resolution, that money vanishes."

As to whether Congress winds up passing a continuing resolution or an appropriations bill, "the answer is predicated on the election," said G. William Hoagland, senior vice president at the Bipartisan Policy Center here. "During the lame duck, Republicans still retain control of Congress. If there's any chance the Senate's going to switch [control] in the 115th [session] -- or even the House -- the pressure will be on [Senate Majority Leader Mitch] McConnell (R-Ky.) and [House Speaker Paul] Ryan (R-Wisc.) to pass not just a short-term continuing resolution but something that will last in 2017, to put their imprimatur on it."

The extremely short time frame will be made even shorter by new member orientations and potential leadership elections, he continued. "And if there is a change in control, there will be such chaos that getting anything done will be difficult."

Ryan is said to be considering a series of "minibus" bills instead of one large omnibus bill, noted Mary Grealy, president of the Healthcare Leadership Council, a coalition of healthcare organizations here. "I think they're looking at doing a series of smaller packages; I'm not sure how far in the future they want to fund."

Mental Health Bill a Possibility

Mental health -- specifically H.R. 2646, the Helping Families in Mental Health Crisis Act, which passed the House overwhelmingly in July -- could be on the docket for the lame duck session, said Sperling, noting that the bill passed the House overwhelmingly, by a vote of 422-2. Over in the Senate, the companion bill "has the entire HELP [Health, Education, Labor, and Pensions] committee -- from [Bernie] Sanders (I-Vt.) to [Rand] Paul (R-Ky.) -- on record" as being in favor, and House and Senate staff members are working hard to reach consensus on the measure.

The House bill includes provisions on interagency coordination for mental health services, setting up a position for an assistant secretary for mental health at the Department of Health and Human Services, and greater emphasis on evidence-based practices in mental healthcare. The House and Senate bills aren't that far apart, although each bill has provisions that its counterpart doesn't have, Sperling said.

"Neither [the House or Senate] is going to take other's bill in toto; we just have to get the Senate to pass it ... We have to have an agreement to limit debate and limit the amendments offered. We're working [on a deal], and I think we're close."

One issue that the lame duck session will have to address is the Medicare Part B premium increase, according to Hoagland. The issue has to do with the annual cost-of-living adjustment (COLA) given to seniors on Social Security -- which in 2017 will be 0.3%. By law, Medicare beneficiaries who also receive Social Security cannot have their Part B premiums increased any higher than their Social Security cost-of-living increase, meaning their premiums next year can only increase by 0.3%.

That leaves the group of Medicare beneficiaries who do not receive Social Security, as well as those newly enrolled in Medicare and those whose Medicare premiums are paid for by Medicaid, to make up any budget shortfall resulting from that low cost-of-living increase. Unless something is done, in 2017 that group -- which comprises about 30% of Medicare beneficiaries -- will be facing a 22% to 25% increase in their Part B premiums come January, he explained.

"We had this problem last year, but [the projected increase] was more like 55% and we fixed it," Hoagland said. "And we said if there was no COLA for 2017, then the same fix would apply. Unfortunately, there would be a COLA ... This is something that's going to hit them in 2017 right away, so they have to deal with that issue in the lame duck [session], and I think they will."

21st Century Cures May Be in the Mix

There is also the 21st Century Cures bill, which has been passed by the House but not the Senate. That bill aims to hasten drug development by increasing funding for the National Institutes of Health and the FDA.

"I know [Senate HELP Committee] chairman [Lamar] Alexander (R-Tenn.) and [House Energy & Commerce Committee] chairman [Fred] Upton (R-Mich.) have been working on this for 2 years," said Hoagland. "Upton will lose his chairmanship in the next Congress and he wants the legacy of this bill."

Hoagland mentioned one other bill -- H.R. 5659, the ESRD Choice Act, which passed the House in September by a vote of 423-0. The bill gives end-stage renal disease (ESRD) patients the option of enrolling in Medicare Advantage. "That might be something to be put on a continuing resolution or omnibus [appropriations bill]," he said.

After the lame duck is over and the new year begins, one issue that will likely be on the Congressional calendar is veterans' healthcare, Gail Wilensky, PhD, senior fellow at Project HOPE, said in an email. "The next Congress will need to contend with continuing challenges from the [Department of Veterans Affairs], including whether to renew the Choice Act ... A 2016 Government Accountability Office report has found continuing access issues, data weaknesses, and lack of a comprehensive scheduling system. These problems are inter-related and it is unlikely that the access issues can be properly remedied without fixing the data and scheduling problems."

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